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Michigan Senate passes Medicaid expansion bill (hello, Indiana?)

Yesterday the Michigan state Senate voted on a plan to expand Medicaid under the Affordable Care Act. The bipartisan measure is supported by Republican Governor Rick Synder, and an affirmative state House vote is expected next week. The only asterisk preventing anyone from saying Michigan’s plan is a sure-thing is that, like Arkansas, they’ll need a waiver from the federal government due it’s partially-privatized structure. As Jeffery Young reports, though, Synder is hopeful for approval:

Snyder acknowledged the procedural aspects of the vote on the Senate bill may delay opening Medicaid to more Michigan residents until 90 days after the legislature adjourns in December, or several months after Obamacare’s Medicaid expansion takes effect. Snyder also conceded that federal authorities still must weigh in, but said his administration has been in close discussions with the federal government as the legislative process unfolds. “We’ve had positive feedback. That said, I wouldn’t call it assurance at this point,” he said.

Assuming they get the go-ahead, Michigan would become the 24th state to accept federal funding for covering low-income Americans under (a sometimes modified form of) Medicaid. As the southern neighbor of that state, I have to then ask; what about Indiana?

As it stands; basically nothing. Relative crickets. Even by the standards of more vitriolic opposition to the Medicaid Expansion my Republican governor has been comparatively silent — sort of, that is, expect for the occasional comment similar to a few days ago when giving the weekly Republican address:

In his address, Pence called HIP an example of the “fresh approaches” that Republican governors are bringing to the nation’s problems.

“This is a perfect example of the truth that by letting freedom and personal responsibility work together, you reduce the need for government,” Pence said. “Republican governors understand this truth, and the proof is in our results.”

HIP stands for Healthy Indiana Plan. For more details you can check out Kaiser’s rundown (PDF), but basically it’s a 2008 pilot program “modeled after a high-deductible plan and health savings account to a low-income population using Medicaid funds.” Right now it covers around 37,000 state residents, with purportedly over 50,000 on the waiting list. Governor Mike Pence has no intention of accepting the Medicaid expansion in it’s current form, which would cover some 400,000 Hoosiers. Instead, at the very least, he’d like to see HIP’s waiver simply extended for another three years. It’s my understanding that the only expansion the governor would support would be an expansion of HIP program.

That position is, well, interesting.

It might be surprising to conservative supporters of the governor that he clearly doesn’t hold a blanket, ideological, opposition to taking federal funding for providing some form of health insurance to the poor. So it’s not a question of “if,” per se, but “how.” Moreover, Pence has reasoned that opposition to expansion as defined under the law is at least partially supported by the idea that the federal government isn’t likely to keep it’s promise of funding. Of course there’s no precedent for that, but wouldn’t such reasoning also apply to an expanded HIP? Yes. Again, it’s not a question of whether to take money, but how that money is spent. The biggest roadblock(s) I see to Pence’s preference lies within HIP’s caps — both annual and lifetime maximums — and to a lesser extent meeting mandatory minimum coverage requirements.

Yet the broader opportunity to expand health care access to low-income Hoosiers isn’t necessarily a dead-end. Michigan will have to go through a waiver process that could last well-into next year. As someone who’d prefer to see our uninsured receive coverage similar to what Michigan and Arkansas are offering over nothing at all, I hope Pence and the more pragmatic state Republican Party pays attention.